基层医院血液透析病人深静脉导管感染相关因素分析及预防对策

Analysis of catheter infection associated factors and prevention measures for hemodialysis patients in primary hospital

目的探讨分析基层医院血液透析病人深静脉置管引起导管感染的相关因素及预防措施。方法 1999年5月至2009年5月,深静脉置管维持性血液透析40例,发生严重感染6例,占15.0%,更换导管时取导管尖端进行细菌培养,并对结果分析。结果引起血液透析深静脉导管感染病原菌为表皮葡萄球菌。置管2、3、6月的感染率分别为16.7%、33.3%、50.0%,锁骨下静脉穿刺置管发生率为0,股静脉置管发生1例,占16.7%,其余5例均为颈内静脉置管,占83.3%。局部护理合理者感染机会少。6例感染者均有护理不得力因素存在。结论引起血液透析深静脉置管感染相关的病原菌为表皮葡萄球菌。导管留置时间越长及护理不得力,则导管感染率越高,锁骨下静脉置管深静脉导管感染发生率低于股静脉和颈内静脉置管。严格深静脉置管护理和缩短留置时间对防止相关性感染具有重要临床意义。

Objective To investigate catheter infection associated factors and prevention measures for hemodialysis patients in primary hospital.Methods Among 40 supportive hemodialysis patients from may 1999 to may 2009,6（15.0%） suffered from severe infection,all catheter tips were taken to bacterial culture when need to renew and the results were analyzed.Results The pathogen of catheter infection in hemodialysis patients was Staphylococcus epidermidis（S.epidermidis）,the infection rates were 16.7%,33.3% and 50.0% respectively after 2,3 and 6 months of deep venous catheter.The infection occurred in 6 cases including 1（16.7%） with femoral vein and 5（83.3%） with internal jugular vein（no infection occurred with subclavian vein duct）.In all 6 infected patients impotent nursing factors existed.Conclusion The pathogen of catheter infection in hemodialysis patients in this study is S.eperdermidis.the longer the catheter is kept,and the more impotent the nursing measures are taken,the higher rate the catheter related infection may occur.The infection rates of subclavian vein catheter and femoral vein catheter are lower than that of internal jugular vein catheter.It is clinically important to strict deep vein nursing and shorten catheter＇s indwelling time to prevent infection.